Covid-19 and Mucormycosis

MUCORMYCOSIS & COVID19

This is a rare fungal infection which is referred to as BLACK FUNGUS, which is seen among Covid 19 patients. It is said that this disease affect people who are on medication that reduces their their ability to fight environmental pathogens. It is being detected in covid 19 patients with diabetes and prolonged Intensive Care Unit stay. This may also turn fatal if uncared. 

WARNING⚠ &SIGNS OF SYMPTOMS:

(Suspected in Covid 19 patients with diabetes or immuno-suppressed individuals) 

• Pain and redness around eyes and Nose
• Toothache
• Skin lesions
• Pleural effusion
• Worsening of respiratory symptoms
• Chest pain
• Facial pain 
• Blurred (or) double vision with pain 
• Blood nasal discharge

PREVENTION:

• Use masks if you are visiting dusty construction sites
• Maintain personal hygiene

Do's & Don'ts : 

Do's ;

• Control Hyperglycemia
• Use steroids judiciously
• Use clean, sterile water for humidification during oxygen therapy
• Use antibodies/antifungals judiciously

Don'ts ;

• Don't miss warning signs and symptoms
• Do not lose crucial time to seek aggressive investigations

I think that,  COVID -19 leads to weakened immune system and this preventing the body from effectively protecting against infection .

As a result,  individual recovering from COVID -19 are at the risk of other infections like mucormycosis. 

And most important thing is that due to this pandemic,  almost half of population 's mental health has worsened and most of them were lost their jobs. 

So only the best solution is to get vaccine. Even after vaccination also we should wear mask,use  hand sanitizer and maintain social distancing ..

Please be aware and get vaccinated.. 

May be the covid patients have weaker immunity,so that they get affected by this black fungus.so getting vaccinated is very important.And the covid patients should be very careful in their day today habits like taking medication,taking nutritional supplements, personal hygiene etc.But also normal people should be careful because we may also get this in coming days that we don't know what may happen.so not only covid patients all should maintain their habits healthy.

In April 2021, India recorded the first case of Mucormycosis or the "Black Fungus" in Gujarat. The dark, necrotic tissues manifested in the affected persons fetched the name "Black Fungus".

When India faced the second wave of the pandemic, with a massive number of 28.2 million cases during mid-May, at that time of crisis, a syndemic "Black fungus" was reported in 9000 patients in the country. India's healthcare system had been struggling with a dearth of oxygen supplies, unavailability of hospital beds, insufficient supply of specific drugs and injections, and this public health hazard had added to the crisis.

The clinical symptoms of Mucormycosis involve -  Swelling in the face, pain and numbness, bloody or black-brown discharge from the nose, Swollen eyes, Nasal or sinus congestion and the most remarkable - black lesions on the nasal bridge or upper inside of the mouth. The treatment modality for Mucormycosis involves Amphotericin – B as an anti-fungal and followed by surgical debridement. A post-Covid-19 secondary infection occurs mainly in immunocompromised individuals especially, in diabetic patients. 

There are various myths and much information (correct and incorrect) surrounding the "Black Fungus". Therefore, these misinformations must be addressed and corrected.

Mucormycosis, prevalence and reasons for surge in cases:

Mucormycosis, caused by a group of moulds called mucormycetes, is a rare but potentially fatal infection if inadequately treated. It is also referred to as black fungus, and the incidence has risen more rapidly during the second wave of COVID-19 in India. The most common causes attributed to the rise of mucormycosis in patients suffering or have recovered few weeks post COVID-19 are;

• uncontrolled diabetes
• post transplants
• some cancer treatments
• excessive use of corticosteroids for immunosuppression
• long-term stays in the intensive care unit

The global prevalence of mucormycosis varied from 0.005 to 1.7 per million population, with nearly 80 times higher (0.14 per 1000) in India than developed countries, from year 2019–2020.

Gold Standard Criteria for clinical diagnosis:

The Smith and Krichner criteria (1950) for the clinical diagnosis of mucormycosis include:

1. Black, necrotic turbinate's easily mistaken for dried, crusted blood,
2. Blood-tinged nasal discharge and facial pain, both on the same side,
3. Soft peri-orbital or peri-nasal swelling with discoloration and induration,
4. Ptosis of the eyelid, proptosis of the eyeball and complete ophthalmoplegia and,
5. Multiple cranial nerve palsies unrelated to documented lesions.

Alarming symptoms:

Rhinocerebral mucormycosis starts in nose and progress to the eye and the brain.

• Nose and Sinus mucor infection (relatively early disease) - can be treated early and reduce complications
  • Headache and nasal obstruction
  • Toothache
  • Skin lesions
  • Loss of sensation on face
  • Blood/brown coloured nasal discharge
• Eye/Orbital mucor infection (moderately advanced disease)
  • Pain and redness around eyes and Nose
  • Facial pain 
  • Blurred (or) double vision with pain
  • Drooping eyelid
• Intracranial mucor infection (very advanced disease)
  • 2nd to 6th cranial nerve palsies
  • Cavernous sinuses involvement
  • Signs of MCA thrombosis

Precautions:

• Monitor blood sugar levels
• Give proper medical history to the doctor
• Use steroids and antibiotics with medical advice.
• Maintain self hygiene and cleanliness.
• Don't self medicate especially corticosteroids
• Don't miss warning signs and do not delay in reporting the symptoms
• Don't ignore medical advice

When symptoms appear, consult doctor immediately.

Treatment Checklist:

• Urgent intervention to prevent loss of eye and reduce progression to next stage - treatment of comorbid illness, antifungal treatment with Amphotericin B.
• Early surgical debridement.
• Management of Post surgical ventilation and care facilities.
• Review of COVID treatment to keep a check on immunocompromise.
• Further confirmation of diagnosis with radiographic images and KOH smear/Biopsy.

Reference links:

//www.ncbi.nlm.nih.gov/pmc/articles/PMC8137376/

//covid.aiims.edu/mucormycosis-in-covid-19/

A sudden incidence of Mucormycosis or Black fungus in relation to COVID-19 has been most aggressively witnessed in India. There are findings which have suggested various factors behind declaring mucormycosis an epidemic by various states in the country. It has been reported that an ideal environment of low oxygen (hypoxia), high glucose (which might be due to diabetes, new-onset hyperglycemia or steroid-induced hyperglycemia), metabolic acidosis, diabetic ketoacidosis, high iron levels (due to increased ferritins) and decreased phagocytic activity of WBCs in the body as a result of immunosuppression from COVID-19 medications, mainly steroids and comorbidities, prolonged hospitalization in ICUs and patients on or off ventilators – all indicate the environment and the posing factors for escalated cases of mucormycosis in India.
Misuse of corticosteroids which require proper interval between doses and monitoring of blood sugar, has been claimed as a significant reason for rising cases of black fungus, pointing towards mismanaged and overwhelmed internal medicine operations within the healthcare system of the country. Glucocorticoids have no benefit in patients who are not on respiratory support. Despite this, many patients with mild COVID-19 not requiring supplemental oxygen have been treated with glucocorticoids and monoclonal antibodies, sometimes with higher doses and longer durations than recommended.
Broadly, to control the incidences of this disease, healthcare providers need to reevaluate the use of steroids in terms of duration and dose. Control of hyperglycaemia, early treatment with liposomal amphotericin B and surgery are essential for the successful management of mucormycosis. Unnecessary and unclear usage of medicines which interfere with immune system shall be avoided.

References for further reading:
1. Awadhesh Kumar Singh, Ritu Singh, Shashank R. Joshi, Anoop Misra, Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India,
//doi.org/10.1016/j.dsx.2021.05.019. ( //www.sciencedirect.com/science/article/pii/S1871402121001570)

2. Gandra S, Ram S, Levitz SM. The "Black Fungus" in India: The Emerging Syndemic of COVID-19–Associated Mucormycosis.
doi: 10.7326/M21-2354
( //www.acpjournals.org/doi/full/10.7326/M21-2354)

3. Revannavar SM, P S S, Samaga L, et alCOVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world?BMJ Case Reports CP 2021;14:e241663.
( //casereports.bmj.com/content/14/4/e241663.full)

The central government has placed Mucormycosis infection under the category of ‘Notifiable Disease’ under the Epidemic Diseases Act 1897. Mucormycosis is an invasive fungal infection caused by molds called mucormycetes, also known as Black Fungus. It is found in water, air. It affects people who have health issues or they use medicines that affect their immunity. Hospitals across the country have started to report cases of Mucormycosis during COVID and post recovering patients. It can affect various organs but mostly seen in some specific organs; ear, nose, throat, and mouth. It is not contagious if it can be detected in an early stage. Headache, vomit, breathlessness, fever, redness, double vision, toothache, coughing etc are some warning signs of this. Patients who have high level diabetes are more prone to this.The basis line treatment of this is Amphotericin B, Anti fungal drug.

Types of Mycormycosis

• Rhinocerebral Mycormycosis: Infection in sinuses and spreads in brain
• Cutaneous Mycormycosis: Infection in skin, mostly occur on those patients which have weak immunity.
• Pulmonary Mycormycosis: Most common type of Mycormycosis of those which have cancer.
• Gastrointestinal Mycormycosis: Mostly occur in children below 1 month of age due to surgery and medication.
• Disseminated Mycormycosis: Infection in bloodstream and affect the organs such as heart, skin etc. It can develop mental status changes or coma.

Way forward

• People with have some kind of medical issues should be more careful and monitor their own health.
• People should modified their life style with simple but effective things such as diet, excersise and maintain their blood pressure and sugar level, more important to control their sugar level.
• Identify the symptoms in early stage and take a effective measures
• Maintain the hygiene
• Masks should be disinfected on regular basis

With such a high mortality rate being reported for Mucormycosis, it's understandable why the reaction towards it has been one of utmost fear. That added to the fact that majority of the cases are in India has just strengthened said fear. 

However, the mortality rate is high - yes. But the incidence of mucormycosis in the first place isn't humongous. It has been deemed to be an extremely rare condition - one which mostly coincides with other factors such as a previously diabetic patient ridden with Covid-19. 

Mucormycosis as is does not usually affect our wellbeing seeing that it is found in huge parts of our environment. Our body has innate immunity towards said condition. Weakening of this immunity due to the extensive use of steroids has seen Mucormycosis develop as a direct consequence. Coupled with hyperglycemia seen in diabetic patients, it is no surprise that it causes so many problems and may prove fatal as well. 

As of now, prevention would be the best way to stop it. For prevention of mucormycosis, prevention of Covid-19 is necessary. Vaccination is the major step towards a covid free future. Take the step. 

Posted by: @ashishjoshi

Please share your thoughts about Covid-19 and Mucormycosis, the black fungus.

Mucormycosis the so called 'Black fungus' is not the consequence of covid infection but rather the consequence of treatment of covid-19.

Use of excessive steroids in diabetic patients infected with covid-19 is found to be the most common prevalence.

The quest to find the mechanism of occurance is still on progress.

Covid-19 and Mucormycosis

    Mucormycosis is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it.

    Uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection with mucormycosis which can develop during the course of the illness or as a sequelae.

    High index of suspicion, early diagnosis, and appropriate management can improve survival.(1)

Pathogenesis of mucormycosis 

     Mucormycosis is a life-threatening infection that occurs in patients who are immunocompromised because of diabetic ketoacidosis, neutropenia, organ transplantation, and/or increased serum levels of available iron. 

      Because of the increasing prevalence of diabetes mellitus, cancer, and organ transplantation, the number of patients at risk for this deadly infection is increasing.

      Despite aggressive therapy, which includes disfiguring surgical debridement and frequently adjunctive toxic antifungal therapy, the overall mortality rate is high.

      New strategies to prevent and treat mucormycosis are urgently needed.

      Understanding the pathogenesis of mucormycosis and the host response to invading hyphae ultimately will provide targets for novel therapeutic interventions.

      In this supplement, we review the current knowledge about the virulence traits used by the most common etiologic agent of mucormycosis, Rhizopus oryzae.

      Because patients with elevated serum levels of available iron are uniquely susceptible to mucormycosis and these infections are highly angioinvasive, emphasis is placed on the ability of the organism to acquire iron from the host and on its interactions with endothelial cells lining blood vessels.

      Several promising therapeutic strategies in preclinical stages are identified.(2)

Treatment 

       The latest recommendations strongly recommend as first-line therapy the use of liposomal amphotericin B (≥5mg/kg) combined with surgery whenever possible.

       Isavuconazole and intravenous or delayed-release tablet forms of posaconazole have remained second-line.

       Many molecules are currently in development to fight against invasive fungal diseases but few have demonstrated efficacy against Mucorales.

       Despite in vitro efficacy, combinations of treatment have failed to demonstrate superiority versus monotherapy.

        Adjuvant therapies are particularly complex to evaluate without prospective randomized controlled studies, which are complex to perform due to low incidence rate and high mortality of mucormycosis.

        Perspectives are nonetheless encouraging.

        New approaches assessing relationships between host, fungi, and antifungal drugs, and new routes of administration such as aerosols could improve mucormycosis treatment.(3)

Citations 

1. Sen M, Lahane S, Lahane TP, Parekh R, Honavar SG. Mucor in a Viral Land: A Tale of Two Pathogens. Indian J Ophthalmol. 2021 Feb;69(2):244-252. doi: 10.4103/ijo.IJO_3774_20. PMID: 33463566; PMCID: PMC7933891.

2. Ibrahim AS, Spellberg B, Walsh TJ, Kontoyiannis DP. Pathogenesis of mucormycosis. Clin Infect Dis. 2012 Feb;54 Suppl 1(Suppl 1):S16-22. doi: 10.1093/cid/cir865. PMID: 22247441; PMCID: PMC3286196.

3. Brunet K, Rammaert B. Mucormycosis treatment: Recommendations, latest advances, and perspectives. J Mycol Med. 2020 Sep;30(3):101007. doi: 10.1016/j.mycmed.2020.101007. Epub 2020 Jun 20. PMID: 32718789.

Last surfed: 21 June 2021

Mucormycosis, also called black fungus, is a fungal infection that is caused by exposure of mould that lives in soil. It’s common to come into contact with these fungal spores because it’s found in dust, dirt, and rotting leaves.

Rising cases of black fungus in India have been linked to widespread steroid use, underlying health conditions, and immunosuppression from COVID-19. People with diabetes, in particular, are at an increased risk of developing the infection.

Treating black fungus requires antifungal medications and surgical removal of infected tissue if it has spread to the brain. Even after people have recovered, there is a chance of long-term neurological complications.

According to the WHO India has reported over 27 million cases with more than 300,000 deaths as of May 26.

drug of choice for its treatment were in shortage as per expert so, The Minister of State for Chemicals and Fertilisers noted that domestic production of Amphotericin B has already gone up five-folds so far. "Domestic production of Liposomal Amphotericin B was just 62,000 vials in April 2021 and now it is expected t...

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We have come across several fungi in our lifetime. There are fungi that are harmful to humans and some that are even useful to the mankind(eg.mushroom)
Among these now the world is facing a dreadful fungus (MUCORMYCOSIS) which arises along with the treatment of COVID 19. The occurrence of mucormycosis has been seen very clearly in the second wave of COVID 19.

The incidence of mucormycosis has risen more rapidly during the second wave compared with the first wave of COVID-19 in India, with at least 14 872 cases as of May 28, 2021.

MUCORMYCOSIS which is also called as BLACK FUNGUS is a rare fungal infection but fatal when untreated inadequately. There are several types of mucormycosis based on the location in the body where they grow. The present type is RHINO ORBITAL MUCORMYCOSIS that affects mostly the eyes,nose,and the skin around it. Patients suffering from this fungal infection typically have symptoms of stuffy and bleeding nose; swelling of and pain in the eye; drooping of eyelids; and blurred and finally, loss of vision. There could be black patches of skin around the nose.

Doctors believe that this fungal growth is triggered by the use of steroids for the treatment of COVID 19 because these steroids are capable of decreasing the inflammation in the lung and also in elevating the blood sugar levels in both diabetic and non-diabetic patients.This increased blood sugar levels provide the suitable resource for the growth of the fungus.

Mostly this condition has resulted in removal of eyes inorder to protect the brain from the fungal spread.Also many patients have lost their lives by this infection .This disease seems to be a nightmare in a pandemic .If there is a problem there is a solution likewise if there is a disease there will be a cure for it .Let’s hope for the cure 👍 

Mucormycosis also known as black fungus is group of moulds called mucormycetes. It can be fatal if not treated properly. In India, Mucormycosis cases were reported more in second wave as compared to the first wave. The Indian Council of Medical Research released guidelines for screening, diagnosis and management of patients with Mucormycosis and COVID-19. Although various measures such as separate wards in the hospital, procuring the drugs, setting up the special tasks force have been taken by states to prevent the infection but still another important measures such as education, dissemination  and communication of the information for  the general public, and monitoring and analysing the situation are required to reduce further mucormycosis cases in patients with COVID-19

read more here:

//www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00265-4/fulltext

Mucormycosis and COVID 19:
• In COVID 19 treatment there is a use of steroids
• In some cases there is an excess use of steroids which leads to increased glucose in blood ( hyperglycemia)
• Mucormycosis is a fungus that is present everywhere that doesn't have much effects on our body
• The increased glucose content in blood favors the growth of this fungus
• This infection causes serious effect which may leads to removal of organ like eyes
• It is mainly caused in diabetes patients where the use of steroid may cause sudden increase in blood glucose level
• Major symptoms: sinusoids, nasal blood discharge,black discoloration on nose etc.